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She ought not to be too fat or gross, but especially not to have thick or fleshy hands and arms, or large-bon’d wrists; which (of necessity) must occasion racking pains to the tender labouring woman…
She ought to be grave and considerate, endued with resolution and presence of mind, in order to foresee and prevent accidents; sagacious and prudent in difficult cases so as not to take all upon her own shoulders and judgment, but to have immediate recourse to the ablest practiser of the art, and freely submit her thoughts to the faculty of the more learned and skilful…
She ought to be patient and pleasant; soft, meek, and mild in her temper, in order to encourage and comfort the labouring woman. She should pass by and forgive her (the woman’s) small failings, and peevish faults, instructing her gently when she does or says amiss: But if she will not follow advice, and necessity require, the midwife ought to reprimand and put her smartly in mind of her duty; yet always in such a manner, however, as to encourage her with the hopes of a happy and speedy delivery.
[Description of the qualifications of the female midwife by John Maubray in The Female Physician (1724) in Cutter & Viets 1964:12]
Midwifery is an occupation based on helping women through the childbirth process that has played a significant role through history. “It is generally recognised that the midwife has been with us since biblical times and that midwifery is the oldest female occupation and without doubt one of the most important” (Marland 1993). The very early description of the midwife above identified a number of key concepts that remain as significant to the role today as they were when John Maubray wrote this. The characteristics of being soft, patient, considerate and pleasant are significant to the part of the midwife’s role in relating effectively to the woman. Those of sagaciousness and prudence relate to the importance of judgment and decision making in safe practice. The ability to ‘submit her thoughts to the faculty of the more learned and skilful’ identifies the issue that the midwife is part of a team of supporters in childbirth and needs to refer to the appropriate other team member when complications arise.
The development of midwifery over the past number of centuries has positioned it, as an occupation, with relatively limited status and authority as compared to medicine. This paper highlights the reasons why this has taken place moving to a discussion of issues relating to the ‘profession’ of midwifery and its power base as part of the team providing services to childbearing women. The hierarchical nature of the National Health Service as a bureaucracy and the power relations within the service are also discussed to set contemporary practice in context.
Historical Context for Contemporary Practice
Throughout most of history, women having babies were attended by women (Arney 1982). Kirkham (1996:167) highlights that the midwife was ‘part of a closely knit community’ in pre-industrial European society and that ‘for many centuries midwives cared for childbearing neighbours when required as part of the fabric of their domestic life’. This situation would have been similar in most parts of the world but developments in Europe from the 16th century led to significant changes which impact on the way midwives practice in the Western World today.
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